Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis

• Published in: Clinical microbiology and infection Vol. 29; no. 10; pp. 1272 - 1279
• Main Authors: Manothummetha, Kasama, Mongkolkaew, Thanuthong, Tovichayathamrong, Punyot, Boonyawairote, Rabhas, Meejun, Tanaporn, Srisurapanont, Karan, Phongkhun, Kasidis, Sanguankeo, Anawin, Torvorapanit, Pattama, Moonla, Chatphatai, Plongla, Rongpong, Kates, Olivia S., Avery, Robin K., Nematollahi, Saman, Permpalung, Nitipong
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2023
• Subjects: Haematologic malignancy; Haematopoietic stem cell transplant; Respiratory syncytial virus; Ribavirin; RSV; Haematopoietic stem cell transplant; Respiratory syncytial virus; RSV; Ribavirin; Haematologic malignancy
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1016/j.cmi.2023.04.021

Ribavirin use for respiratory syncytial virus (RSV) infection in patients with haematologic malignancies (HM) and haematopoietic stem cell transplant (HSCT) recipients remains controversial. To summarize the current evidence of ribavirin treatment in association with mortality and progression to lower respiratory tract infection (LRTI) among patients with HM/HSCT with RSV infection. MEDLINE, Embase, and the Institute for Scientific Information Web of Science. Randomized controlled trials and observational studies investigating the effects of ribavirin, compared with treatment without ribavirin, for RSV infection. Patients with HM/HSCT. Ribavirin versus no ribavirin. The risk of bias in non-randomized studies of exposure (ROBIN-E). The random-effects model was used to calculate the pooled OR (pOR) with 95% CI for the pooled effect estimates of ribavirin benefits. Grading of recommendation assessment, development, and evaluation was used to evaluate the certainty of evidence. One randomized controlled trial and 14 observational studies were included, representing 1125 patients with HM/HSCT. Ribavirin use was not associated with lower all-cause or RSV-associated mortality with pORs [95% CI] of 0.81 [0.40, 1.66], I2 = 55% (low certainty of evidence) and 0.48 [0.11, 2.15], I2 = 64% (very low certainty of evidence), respectively. In subgroup analyses, ribavirin use was associated with lower mortality in patients with HM/HSCT with LRTI with pOR [95% CI] of 0.19 [0.07, 0.51], I2 = 0% (moderate certainty of evidence). In subgroup analyses among studies providing adjusted OR, ribavirin use was associated with lower all-cause mortality with pOR of 0.41 [0.23, 0.74], I2 = 0% (moderate certainty of evidence). In addition, aerosolized ribavirin was associated with lower progression to LRTI with pOR [95% CI] of 0.27 [0.09, 0.80], I2 = 71% (low certainty of evidence). Ribavirin may be a reasonable option to treat RSV in patients with HM/HSCT in the absence of other effective antiviral agents.